Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Endosc Ultrasound. 2014 Apr;3(2):109-17. doi: 10.4103/2303-9027.123009.
Endoscopic ultrasound (EUS) is one of the best diagnostic methods for diseases of the digestive tract and surrounding organs. Whereas EUS-guided fine needle aspiration (FNA) has been very useful for providing histological confirmation for previously hard to reach lesions, elastography is aiming to obtain a "virtual biopsy" by assessing differences in elasticity between the normal and pathological - usually malignant - tissue. A question that arises is whether EUS-elastography has reached a stage where it might successfully supplant the use of EUS-FNA in some of its clinical indications. The main indications of EUS-guided FNA are listed in this article and published data on the usage of elastography in these settings is reviewed for each one. In some of the indications, a plethora of studies have been published, notably for the evaluation of solid pancreatic masses and lymph nodes, while in others there is little relevant data (submucosal masses, left liver lesions, left adrenal masses), or elastography simply is not suitable as a diagnostic means (cystic lesions). Our conclusion is that elastography is not yet ready to replace EUS-FNA in its indications, but should complement it in various settings, especially for the assessment of lymph nodes. It can only be considered an alternative on a case-by-case basis, in situations where FNA is regarded as a contraindication. Furthermore, it could be used in conjunction with other imaging techniques, such as contrast-enhanced EUS, in order to further improve the accuracy of non-invasive EUS assessment, possibly making the case for a more limited or targeted use of EUS-FNA in selected cases.
内镜超声（EUS）是诊断消化道及周围器官疾病的最佳方法之一。虽然 EUS 引导下的细针抽吸（FNA）对于提供以前难以触及的病变的组织学证实非常有用，但弹性成像是通过评估正常和病理（通常是恶性）组织之间的弹性差异来获得“虚拟活检”。一个问题是，EUS 弹性成像是否已经达到了在某些临床适应证中成功替代 EUS-FNA 的阶段。本文列出了 EUS 引导下 FNA 的主要适应证，并对每种适应证下弹性成像的使用情况进行了综述。在一些适应证中，已经发表了大量研究，特别是用于评估胰腺实性肿块和淋巴结，而在其他适应证中，相关数据很少（黏膜下肿块、左肝病变、左肾上腺肿块），或者弹性成像根本不适合作为诊断手段（囊性病变）。我们的结论是，弹性成像尚未准备好在其适应证中替代 EUS-FNA，但应在各种情况下对其进行补充，特别是用于评估淋巴结。只有在 FNA 被认为是禁忌症的情况下，才能根据具体情况考虑将其作为替代方法。此外，它可以与其他成像技术（如增强 EUS）结合使用，以进一步提高非侵入性 EUS 评估的准确性，可能使 EUS-FNA 在某些选定病例中的使用更有限或更具针对性。
